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Approximately 50% of the normal rotation of the cervical spine occurs at the atlantoaxial motion segment. Factors that lead to instability at the atlantoaxial junction include traumatic injury to the axis or atlas and traumatic ligamentous injury. Other pathologic processes that lead to instability at C1-2 include inflammatory conditions such as rheumatoid arthritis, congenital lesions, malignancy, and severe osteoarthritis. Because of the high degree of motion at this level, rigid internal fixation provides the most stable construct to facilitate bony fusion.
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